Business Contact and Services Form
Please provide your contact information and details of services for evaluation
Full Name:
Company Name:
Email Address:
Phone Number:
Address:
City:
State
New South Wales
Victoria
Queensland
South Australia
Western Australia
Australian Capital Territory
Northern Territory
Post Code
Original Supplier Section
Supplier Name
Internet Speed (Mbps)
Internet Monthly Cost ($)
Phone Service Description
Phone Services Cost($)
Extra Services Comments
Extra Services Cost($)
Total Costs
Total Costs
Jollytel Offer Section
Internet Speed (Mbps)
Internet Monthly Cost ($)
Phone Service Description
Phone Services Cost($)
Extra Services Comments
Extra Services Cost($)
Total Costs
Total Costs
Estimated Total Cost saving (Original Supplier - Jollytel Offer)
% Savings with Jollytel Offer
Notes
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